MONTAGES OF OUR LIVES ORDER FORM
Adrianne Bentley
P.0. Box 1044 West Jordan, UT 84084
Phone 801-809-6546 or Fax to: 801-282-5282, 12533907737 or 801-446-0552
Email: adrianne21@aol.com or retodd4fun@hotmail.com

Print this form and fill it out. If you cannot print it directly from the web, save it on your computer, then print it.
Enclose photos, music & captions for each photo, check or Credit card information.
Send it to the above Address or Fax or Email

Ordered by:
Name:_________________________________________________________________________

Address:_______________________________________________________________________

City:__________________________________________________State_______Zip___________

Phone: Day (____)_________________________Evening: (____)________________________

Please include your Email address:________________________@___________________________

so that we can notify you of the shipment date.

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Item Description_________________________________Quantity___Item Price____Total Cost

1. ________________________________________...._____.......... _______........_________

2. ________________________________________...._____.......... _______........._________

3. _________________________________________...._____........ _______...... _________

Sub-Total___________________

Sales Tax (Ut residents add 6.5%) _______________

Shipping and Handling ($4.00 Priority)(_______________

TOTAL_______________________

Payment :

Check or money order payable to Adrianne Bentley. Check enclosed..#___________
..........................................................................................................................................

MasterCard_#______________________________Visa_#_________________________________

Name on the card_______________________________________________Exp. date____/___/_____

Signature_____________________________________________________________________
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